188 84lH ACSA ANNUAL MEETING DESlGNlDESlGN STUDIO 1996

Architecture as Environmental Medicine

PHILLIP G.MEAD Newschool of Architecture

INTRODUCTION under Caesar Augustus, because a portion of his book The Ten Books on Architecture is devoted in depth to military breach- What is the practice of architecture? How does the public ing machines and fortification design. perceive what we do and how does that differ from the way Vitruvius, as a military engineer, was essentially a castle we view ourselves? Are we artists whose ultimate goal is to maker; thus his thinking was protective in nature. Architects express the "spirit of the age" or are we plan coordinators who add a touch of zeitgeist here and there for effect. As are, in a way, castle makers who provide protection from the creators concerned with the influence buildings and land- elements, casualties, and criminal activities. Shelter, our scapes have on the public's well being and as licensed primary form of protection, is a form of preventative medi- professionals sworn to secure the health, safety and welfare cine. Likewise our skin protects our bodies from countless of the public, it's time to acknowledge a part of us that we numbers of parasitic viruses and germs. But Vitruvius' have failed to recognize or promote, that of "environmental thdung wasn't limited to protection alone; it also included physicians." Our history is rich with medical associations. ideas of sustainability (not the kind of sustainability that The first recorded architect,Irnhotep (designer ofbgZoser's focuses on responsible ecological energy production and pyramid) was also aphysician who after his death became the consumption, but sustainability as biological nourishment). god ofhealing. Some of our most revered works: The Love11 His secondary duties as a military engineer consisted of Houses, Richards Medical Laboratories, The Salk Institute finding healthy sites with clean water, air and vegetation for and the recently completed Neuroscience Institute in La Jolla, the set-up of military camps. For the remainder of this paper, were designed in collaboration with the medical community. this idea of sustainability and protection will include the If we recognize the church as a spiritual as well as physical physical as well as psychological and spiritual qualities in healer (most hospitals before the 20th century were run by design. churches) then our collaboration as builders of the houses of healing is extensive. Site Throughout history, architects have examined and em- Both protective and sustainable thinking are inherent with ployed: 1. the properties of site, 2. the art of placement, and Vitruvius' declaration in the Ten Books on Architecture that 3. the qualities of light and air to improve our health and the first priority of site design is health.' He recommends not quality of life. Thls re-examination of the historical writings building structures or cities on a valley floor or near marshes and projects that have embraced environmental health issues because bad air and swamp creatures dwell there. (The (physically, psychologically and spiritually) from ancient Asian art of placement, Feng Shui, makes a similar Marcus Vitruvius to Richard Neutra, and from recommendation in not only avoiding the hill bottom but also Christopher Alexander to the Building Codes, indicates that the top to avoid harsh winds. Vitruvius advises that once a we have contemplated health-conscious design for thousands site is chosen, cattle should graze the area for a "sufficient of years. Understandingthls history can help students develop time" after which a few should be slain to see if their livers responsible design convictions and furthermore act as a have an unhealthy discoloration. If so, then like a good springboard for research and design methodology. scientist, the architect should examine other cattle to deter- mine whether the site is ~nhealthy.~(Can soils tests today SITE, PLACEMENT, LIGHT AND AIR claim to do the same)? Protective and Sustainable Thinking Vitruvius also advises how to find and classify sites with The first theorist to address environmental health issues was health-restoring springs, declaring that sulk springs cure Marcus Vitmvius Pollio. Although little is known oflritruvius, pains in sinews and aluminous springs aid in the treatment of it is speculated that he was a high ranlung military engineer paralysis.' Today we still recognize the medicinal benefits of 84TH ACSA ANNUAL MEETING DESlGNlDESlGN STUDIO 1996 189 hot springs. Cracks and fissures in the earth, where gases and Language, which is an orderly listing of sustainable arrange- springs emerge, are places where religious healings also tend ments or "patterns." Although many consider A Pattern to occur which explains the presence of temples in these areas. Language an insult to artistic expression, its prescriptions are Throughout the centuries one religious temple has been generally backed up with scientific data or first hand observa- replaced by another, according to the dominating religion of tion, and its "patterns" (minus its construction details) are the time, on these same sacred ground^.^ flexible enough to accommodate a variety of expressions. As Even in America, Christian buildings now have replaced most of us know, and as Alexander will adrmt, A Pattern Native American healing sites. An example ofhscan be found Language is not the last word on healthy design; but it is not near San Bernardino at Arrowhead Springs located a few a bad start. hundred yards from the San Andreas Fault. It was fmt used by Native Americans as a place of healing, but, after the Anglo- Light Americans took over the region, a bath house was erected The use of light as a regenerative and purifying agent has long which claimed to cure many ailments. Through misrnanage- been recognized in health conscious design, particularly in the ment the business died, but today a religious retreat center design of temples, houses and hospitals. In the placement of called Campus Crusade for Christ occupies the site. temples, Vitruvius suggests that they face the west so that the worshipper can behold the morning sun when viewing the Placement temple and its priest.' This theatrical maneuver is a reminder The correct placement of paths and buildings with the of the regenerative role of the sun with its life-giving light. A appropriate arrangement of their parts has been a strong western orientation is archetypical, for it occurs not only in concern in the history of environmental medicine. In ancient Roman temples but also in Ancient American temples and America and Europe, environmental shamans placed plazas, Early Christian to Gothic cathedral design. Greek mythology avenues and buildings in relation to sacred geographical and reinforces the perception of light as a healer by worshipping celestial features to help nature regenerate and heal itself so Apollo and his son Aesculapius as healers. Christianity sees that, in the end, civilizations would not go h~ngry.~In Asia Jesus as the "light of the world." the ancient art of placement, Feng Shui, prescribes sustain- Abbot Sugier, the father of Gothic church design, took the able and protective advice for the correct placement of regenerative role of light one step Merwith his design of buildings and components relative to each other and to the St. Denis outside Paris. In the 1 loo's, St. Denis was the first natural environment. cathedral to extensively use stained glass. Abbot Sugier's The Ten Books on Architecture also recommends the writings show that the immaterial can be reached by way of correct placement of temples. The Temple of Mars, Vitruvius the material in the contemplation of certain pieces of art; advises, should be placed outside the walls of the city so that mainly art using reflective gems. These "small lamps," as he Mars can act as an advanced guard to protect the town from writes, can help the individual towards redemption and thus enemy attack. His advice on the placement of Vulcan's spiritual healing.8 His fondness for reflective gems in the temple outside the city walls, foreshadows today's fire codes.6 decoration of his art then carried over into his idea of installing Apparently Vulcan's ceremonial fues occasionally got out of large stained glass windows in St. Denis. control and spread to surrounding buildings. One could say Eight hundred years later, Christian Shakers in America that Vitruvius' concern with fire containment, through correct also looked to light as an aid to redemption. placement, has evolved into the complexity of today's build- Shaker Eldress Arelia Mace wrote, "Good and evil are typi- ing and fire codes. Since fire is the number one catastrophe fied by light and darkness. Therefore we bring light into a dark that plagues our buildings and since fires are known to kill and room, the darkness disappears, and insomuch as the soul is maim thousands of people each year, it is imperative that filled with good, .... evil will disappear." Shaker communal students develop a respect for the codes instead of regarding houses, even barns and chicken coops are well lit with many them as a shackle to artistic creativity. Like the building large windows and sophisticated skylights. Interiors are codes, our own body's genetic code is full of contingency painted white and trimmed with dark blue. Even interior plans for the prevention and containment of disease. Despite hallways and closets borrow light from adjacent rooms by the complexity of instructions in our genetic code, it does not inside window^.^ appear to have compromised the richness and beauty of our The purifying effect of light was also recognized by the species. Just as our own genetic code has evolved into a highly medical community around the turn of this century at the complex and redundant information system, we can only discovery that sunlight could kill bacteria. According to expect the building codes to do the same. Brown University doctoral candidate James Ross, this dis- Basing the design of our environment, however, solely on covery prompted sanitariums to orient windows to the south the prevention of fues or accidents that may or may not happen so harmful microbes could be killed by the sun.I0 This in turn a few times in a lifetime precludes the day to day, minute to affected some of Frank Lloyd Wright's designs (further minute sustainable, or nourishing, aspects that correct place- elaboration will be given in the section on air quality). ment can provide. One book that counterbalances the protec- The regenerative qualities of a sunrise can not only tive attitude ofthe codes is Chnstopher Alexander's A Pattern rejuvenate the spirit but the body as well. Vitruvius advises 190 84THACSA ANNUAL MEETING DESIGNIDESIGN STUDIO 1996

that bedrooms should face east presumably to help awaken major physiological and psychological impact. When inhabitants." Chnstopher Alexander gives similar advice, these so called "witches winds" blow, there is a correspond- citing studies by Dr. London of the San Francisco Medical ing increase in colds, headaches, lethargy and emotional School on the effectiveness of our daily activities and its outbursts. Crime and suicides are known to increase relation to how we are awakened in the morning. Alexander sharply, causing some judges in Israel to give lenient concludes from Dr. London's studies that ifwe are gradually sentences when the crime is committed during the Sharav awakened by the increasing light of the rising sun, we wake wind.IR Although not without scientific controversy, some up in a refreshed condition which promotes a more produc- studies contend that these winds give the air a positive tive day. In contrast, if we are jarred awake by an alarm electrical charge, which causes an unmanageable increase clock, perhaps from a deep sleep, then we will wake up in the flow of one of our body's neurotransmitters called groggy and find it difficult to function normally during the "serotonin." Serotonin is a stimulant which, if left "on" for day.I2 Vitruvius' and Alexander's advice is further but- longer than normal, can cause a person to "burn out" and tressed by psychiatrist Daniel Kripke of the University of become irritable.I9 Vitruvius' countermeasure to these California San Diego, who claims that: people that sleep in winds is to orient the city streets at an oblique angle to break bedrooms facing east are likely to get up earlier and sleep less them up. Vitruvius also advises not to place alleyways than those who sleep to the west." parallel to the winds, which can rapidly spread noxious The regenerative benefits of light can also be found in odors and disease through the town."'O Richard Neutra's book Survival Through Design. Here he The effect of moisture on air quality has also been a cites an inter-professional study consisting of physicians, concern from ancient history until today. Moisture from educators and illumination engineers that analyzed the light leaky roofs, walls and improperly drained soil that can filter distribution in elementary classrooms. The investigators into basements and crawl spaces, can be breeding grounds arrived at an optimum brightness ratio from 1 to 5 every- for mold. This mold then produces spores which circulate where. The impact on the students was impressive. Sixty into the air and play havoc with some people's immune five percent of the children who suffered from refractive eye systems. These people can be sick for years without knowing problems were liberated from their glasses after six months. the cause of their illness. Additionally, malnutrition symptoms dwindled, according Vitruvius' advice for this malady was simple: stay away to Neutra, "because energies were preserved by eliminating from swamps. Frank Lloyd Wright's was also simple: do muscular strain caused by malposture and growth difficulties away with damp basements and crawl spaces and build right due to visual trouble." These results prompted further on the Palladio's advice was more detailed and studies which found that "50 percent of dental trouble due to practical. In the Four Books on Architecture Palladio faulty jaw positioning may have been due to forced general advised that roof configuration was the key to keeping out posturing caused by poor light."I4 water. He paraphrased Vitruvius' advice against flat roofs by Doctors today also use light to treat an illness known as pointing out that they are prime candidates for water leakage. seasonal depression. Because the lack ofwinter sunlight can A sloping roof with a 3:12 pitch is sufficient for water cause severe depression in people who live above the 48th drainage... less pitch the more likely the roof will leak; more parallel, a bank of full spectrum fluorescent lights is pre- pitch will require unnecessary construction labor. (Note: the scribed to restore the body's normal balance of a neurotrans- majority of Palladio's roofpitches are 5: 12 which means that mitter known as melatonin.I5 either he did not follow his own advice or the "3: 12" is a misprint). To keep water away from the walls and founda- tions Palladio advised a 1 % foot roof overhang with gutter Air and a downspout that drained water well away from the The quality of air that we breathe has long been of concern foundati~n.~~ to architects. Once again it is Vitruvius who first discusses Before the Mid 1 goo's, "bad air" was seen to be the source air quality and health. As mentioned earlier, Vitruvius of disease. The malady known as malaria simply means "bad recommended not to build on valley floors or near swamps air." The "bad air" or "miasma" theory of disease began to because of the "bad air." Today we know that valley floors change around the middle of the nineteenth century. Scien- are places with the highest concentrations of air pollution. tists found that it wasn't so much the noxious gases from the Vitruvius even distrusted the air quality of some winds earth which caused disease, but things carried in the air that because he noticed that certain winds bring a corresponding was harmfd. The "bad air" near swamps mentioned by rise in sickness.16 Four hundred years earlier, Hippocrates, Vitruvius is not detrimental itself, but the mosquitoes that the father of rational medicine, noticed that some winds breed in swamps can cany malaria. Harmhl bacteria and induce "dullness of hearing, dimness of vision, heaviness of viruses are also carried in the air. This was a fundamental head and langour."" We know these to be fairly accurate discovery in the mid 1800's. observations for certain winds around the world such as the At the time, John Rushcriticized the immoral effects of Santa Anas in Southern California, the Sharav in Israel and the industrial revolution and looked back in time for a more the Chinooks of the Pacific Northwest are known to have healthy version of artistic expression, the world of medicine 841H ACSA ANNUAL MEETING DESIGNIDESIGN STUDIO 1996 191

radically jumped forward. Two scientists: a Frenchman that minimize bacteria. named Louis Pasteur and a Scot named Joseph Lister, The recent concern for "bad air" takes the form of "indoor revolutionalized the medical community and in the end, air pollution." Radon gas from radioactive soil lealung up significantly extended the length of our lives. Pasteur's work into basements causes lung cancer. Inexpensive formalde- on bacteria, immunization and milk pasteurization effec- hyde-based glues in plywood or particle board and gas leaks tively increased the medical profession's ability to prevent from stoves and furnaces are all released into the indoors. All and combat life threatening diseases. Joseph Lister built on of this can weaken our immune systems. Before the 1970s Pasteur's findings and promoted the practice of surgeons energy crisis, gases could escape easily through gaps in washing their hands and sterilizing instruments before sur- construction, but, since the energy crisis's mandate of air- gery to prevent infection and transfer of disease. The tight construction, they are are contained and re-circulated in findings of Pasteur became known as "germ theory" which our buildings, causing higher rates of sickness. More effectively replaced "miasma theory." After the ideas of ventilating and building with non-toxic materials, better Pasteur and Lister were implemented and expanded upon by HVAC systems and rigorous maintanance help relieve the other scientists, life expectancy nearly doubled. They gave toxicity of interior air. us a second lifetime. These findings made a significant impact on building VISUAL SUBJECT MATTER design at the turn of the century. Ways of eliminating germ So far, we have discussed the protective and sustainable build-up in buildings became a prime concern. According to qualities of site, placement, light and air. Additionally, what Brown University doctoral candidate James Ross, who is we see can affect our health. Historically, a great deal has working on a dissertation entitled "The Impact of the Nine- been written on the aesthetics of what we see, but the teenth-Century Public Health Movement upon American medicinal consequences have not been discussed with any Architecture," the health and safety of public buildings scientific validity. Can we say with certainty that it is changed drastically. healthier to look at an Arts and Crafts creation than a In reaction to the nineteenth-century public health move- Deconstructivist piece? These movements may express a ment, design elements began to change. More glass began healthy social value, higher truth or zeitgeist, but how can we to appear in designs because it was discovered that sunlight measure their biological or psychological medicinal value? killed tuberculosis and microbes. Since ornament collects Nevertheless, recent evidence is revealing that what we see dust and germs, stylistic attitudes began to change towards could be of medicinal value. Color studies indicate that red cleaner lines and flat surfaces. Good ventilation became a increases our blood pressure while blue lowers it.25 An prime consideration in eliminating germs.23 investigation by Geographer Roger Ulrich in the seventies One of the building types most affected by these discov- shows that the right kind of window view can aid the healing eries was the school building. Schools were, and still are, process. His study verifies that postoperative patients who considered centers of disease transfer; therefore special were given a view of a tree recovered faster with lower doses consideration was given to their design. These schools of pain killers than patients with the same operations who implemented courtyard plans, high ceilings, large windows viewed a brick wall.2h These kinds of studies can open up a and raised first floors which encouraged the movement of whole series of questions and avenues of research on the fresh air to exhaust airborne bacteria. Additionally, large sustainable qualities of visual ambiance. What kinds of windows allowed in more sunlight to lull germs.24 physiological reactions do we get from a horizontally, Frank Lloyd Wright and Irving Gill are two turn-of-the- vertically or diagonally composed elevation? What effect century architects who utilized some of these principles. Gill does a floor plan, elevation, or space without a sense of wrote and spoke about the sanitizing qualities of his designs repose have on us? Further research could help us find these and implemented several innovative details in his house that answers. simplified cleaning and minimized germ build-up. These details include, but are not limited to, rounded comers CONCLUSION between floor and wall, flush trim and raised bathroom and closet floors. Some of his details are still found in hospital Today, even though we have a multitude of health-con- design today. scious design information, it is underutilized in the studio Wright's 1908 Robie House incorporated several germ- environment. Part of the reason could be that the informa- eliminating strategies. Doctoral candidate James Ross claims tion is unorganized. Other than the Building Codes or that the Robie House is similar to a sanitarium. As is typical Alexander's A Pattern Language there is scarcely a book with Wright's Prairie Style homes, the Robie House's main that is similar to a medical reference book. The other living areas is placed on the second floor because the space problem is with the perception of these two books: they next to the ground was seen to harbor "bad air" and therefore seem dogmatic and contrary to free artistic expression. more germs -- a leftover idea from "miasma theory." On the Another problem is the perception that the environment's entire south side of the second floor are placed a bank of effect on our health is negligible. Evidence suggests operable glass doors which allows plenty of sun and breeze otherwise. We seem to be at the same nebulous place the 192 841HACSA ANNUAL MEETING DESlGNlDESlCN STUDIO 1996 medical community was 130 years ago before Pasteur's Ross, James. "The Impact of the Nineteenth-Century Public revolutionary discovery of bacteria's ill effect on health. Health Movement on American Architecture." Proceedings of the Society of Architectural Historians. Seattle, Washington, With a focus on environmental health by: 1. integrating Spring 1995. health subjects in architectural history and studio courses, Vitruvius, p. 181. 2. encouraging students to take courses in biology and Alexander, Christopher. A Pattern Language. Oxford Univer- medicine, and 3. by collaborating with the medical commu- sity Press. New York, 1977, pp. 657-9. nity in research, architecture could build on medical knowl- Gallagher, op. cit., p. 49. Neutra, Richard. Survival Through Design. Oxford University edge gained from traditional theory to become an effective Press. New York, 1954, p. 308. form of medicine. Gallagher. Op. cit., p. 49. Vitruvius. Op. cit., pp. 24-25. Hippocrates. On Airs, Winds and Waters. Reprinted in The BIBLIOGRAPHY Great Books of the Western Age. Edited by Robert Hutchins. Encyclopedia Britanica. Chicago, 1952, pp. 9-1 9. Morgan, Morris Hickey. 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